Provider Credentialing Specialist

Flexstaff is hiring a Provider Contract Specialist to join our client's team. This is a long term assignment.The Provider Contracting Specialist is responsible for the development, negotiation, and management of contracts with providers.

Location: Olinville

Setting: Hybrid, 1-2 days in office, schedule can change at any time, so flexibility is required.

Pay Rate: $27/hr

Schedule: Monday - Friday 8:30 am-5:30 pm (1 hour lunch)

Contract Length: Temp

JOB RESPONSIBILITIES:

• Develop, negotiate, and manage contracts with IPA's, primary care

practices, specialty practices, LHCSA agencies, FQHC's, ancillary

providers, hospital systems and other provider groups.

• Track and monitor provider performance to ensure contracts meet the

organization's objectives, including financial terms, compliance, and

quality of care requirements.

JOB DESCRIPTION

• Track and manage contract terms and renewals to ensure timely

execution.

• Administer the on-boarding of new providers through the SCA process,

data enter and update provider contracting tracker (PORF) and Care

Compass. Track and monitor each SCA to ensure the closing of the SCA

through contract conversion or termination.

• Maintain accurate records of contract negotiations, amendments, and

renewals in the contract management system.

• Collaborate with internal teams, including legal, compliance, and

finance, to draft, review, and finalize provider contracts.

• Assess and analyze provider performance and market conditions to

support negotiation strategies.

• Respond to provider inquiries and resolve contract-related issues in a

timely and professional manner.

• Ensure compliance with all relevant federal and state regulations, as well

as organizational policies and procedures.

• Assist in the development of provider networks by identifying new

potential providers and building relationships.

• Monitor and report on key performance metrics related to provider

contracting and network development.

• Provide training and guidance to internal teams regarding contracting

processes and best practices.

• Performs job responsibilities according to organization's policies. Seeks

clarification when needed.

• Assumes responsibility for assignments given, seeks supervision

appropriately, and is accountable for work performance. Meets

productivity guidelines.

• Maintains proper documentation (updated, timely, legible) related to

patient care, whether paper or electronic.

• Maintains HIPAA standards and confidentiality of PHI.
• Other duties as assigned.

Service Standards

• Timely and Accurate Contract Negotiation

QUALIFICATIONS:

Education: Bachelor's degree in Business Administration, Healthcare

Management, Finance or related field preferred or equivalent

combination of education and experience.

Experience:

• 1-2 years of experience in healthcare provider contracting, managed

care, or a related role.

• Vendor/ provider contracting experience is strongly preferred.
• Working knowledge of Medicare and Medicaid is required. Health

plan/managed care setting, preferred.

• Experience in administrative support roles that involve data entry,

documentation, or working with data is required.

• Attention to detail, critical thinking, time management skills, a sense of

urgency.

• Strong interpersonal and communication skills with the ability to work

collaboratively across departments.

• Discretion with highly sensitive information, including credentialing files,

sanction lists, claims, and remittance information.

• Attention to detail and ability to maintain accurate records.
• Excellent organizational and time-management skills.
• Knowledge of Healthcare regulations (i.e.- HIPAA, CMS, etc.) and a

commitment to patient data privacy and security.

• Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and the

ability to learn contract management software quickly.

Additional Salary Detail

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).